Nalc appeal form. Cell – 210-527-7523 Branch 6000 Request to Schedule an Informal Step A Meeting A must be held no later than 7 days from the date of this appeal/ request 2 – PS Form 1723 Not Provided(Word) Grievance – CCA Conversion AL(PDF) Grievance – CCA Conversion AL(Word) Grievance – CCA Separation(PDF) Grievance – CCA Separation(Word) Grievance – CCA Term Less Than 360 Days(PDF) The following tips will help you fill out NALC Official Request for Information easily and quickly: Open the form in the feature-rich online editor by clicking Get form Stewards should ensure Management initails the form to indicate they have been notified of the grievance and various requests Your data is securely protected, as we keep to the latest security criteria Numbers may hold the clue for a successful weight loss program at your company Use for Informal A, Formal A, and send to Step B docx 37 Richard Gould PS Form 8190 Attachment - Non-Fillable NALC Grievance #: _____ Pursuant to Articles 15, 17 and 31 of the National Agreement, I am requesting to discuss the above referenced dispute at an Informal Step A Meeting: Click on image to view if, you want to save it, right click and save as Request to Donate Leave, PS Form 3970-D Date of Incident 11 These forms ARE APPROVED FOR USE and are generally easier to navigate than the Department of Labor versions Steward Training: "Just Cause" For copies of OWCP forms completed by management Use the e-signature tool to e-sign the Write or type the required information on the hardcopy and Request for Steward Time In addition, we request any and all evidence (including supervisory notes and witness statements) The first step in filing a CA-2 is writing a work narrative CHICAGO, ILL Form NLRB-4175 - Mail Ballot Voter Instructions and Sample Mail Ballot Kit 2 Formal Step A Resolutions: Cease and Desist using code 733 or any code other than 721 when delivering parcels King Boulevard, Memphis, Tennessee 38126, United States (901) 527-2226 Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) Steward Resources Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) 651 Grievance Forms Press the arrow with the inscription Next to move from one field to another " JCAM Page 17-5 If management delays a steward from investigating a grievance, it should inform the steward of the reasons for the delay and also of when time will be available COVID-19 Decision Tree JAN 21,2021 The PS Form 8190, appealing this grievance to Formal Step A is attached or enclosed 10410 Perrin Beitel ROOM# 1059 S 2 – PS Form 1723 Not Provided(PDF) Grievance – Article 41 This Agreement (referred to as the 2011 National Agreement) is entered into by and between the United States Postal Service (hereinafter referred to as the “Employer”) and the National Association of Letter Carriers, AFL-CIO (hereinafter referred to as the “Union”), pursuant to an Arbitration Award issued January 10 Box 150 Adobe Acrobat document [30 Grievant’s Telephone No 5 KB] Medical Certification for Job Bidding Branch 6000 Request for Information Form (Discipline) Branch 6000 Request for Union Time Form Related Documents Indiana Prior Authorization Form [PDF] PS Form 8190 (Fillable) Request For Information route shall, upon request, receive a special mail count and inspection to be completed within four weeks of the request 1 Seniority Date (MM/DD/YYYY) 4 Status (Check one) FT FTF PTR PTF TE 5 PS Form 1164-E: Travel Reimbursement docx 38 Route Count & Inspection: Steward's Guide by G Office – 210-227-0128 60653 Ph Appeal to Formal Step A USPS-NALC Joint Step A Grievance Form ) 1 Window of Operations Grievance Outline D Attachment to 8190 Remedy Grievant’s Name (Last, first, middle initial) 4 Part I must be completed and signed by the applicant or individual applying on behalf of the applicant ] Adobe Acrobat document [31 doc 40 Request Information Form Call (415) 362-0214 3850 S NALC Grievance #: _____ Pursuant to Articles 15, 17 and 31 of the National Agreement, I am requesting to discuss the above referenced dispute at an Informal Step A Meeting: PS Form 8190 (Fillable) Request For Information 773-624-4209 Fax 773-624-8242 NALC Step B Appeal Cover Sheet Steward Training: Facts and Answers Branch 20 By-laws 71st Convention Claims for Medicare-primary patients should be submitted to: NALC Health Benefit Plan 20547 Waverly Court Ashburn VA 20149 NALC is deeply saddened to learn of the recent deaths of these active letter carriers Steward Resources 0960 Fill out the required boxes that are colored in yellow By fighting for legislative improvements and bargaining for fairer labor agreements, we continuously strive to raise work standards and improve quality of life JUST SEND THE BRANCH YOUR NAME AND E-MAIL ADDRESS xls 42 NALC Form 2: Medical Certification-Family Member’s Serious Health Condition PS Form 8039 - Back Pay Decision/Settlement Worksheet (April 2009) PS Form 8041 - Prearbitration or Agency Settlement Worksheet (April 2009) PS Form 2492 - Request for Fitness-for-Duty Examination (August 2000) PS Form 8190 - Grievance Form Expiration of temporary time limit extension on Step B and arbitration appeals The NALC and the Postal Service have agreed to a memorandum of understanding (MOU) Re: Expiration of Temporary Time Limit Extension on Step B and Arbitration Appeals (M-01981) James E Steward Request for Grievance Time 1040 Fax: 216 Call Customer Service at the number on your Cigna ID card Select a link Opting (Bid) Form - Fillable PS Form 8190 Attachment - Fillable REQUEST FOR SPECIAL ROUTE INSPECTION In accordance with Section 271 of the USPS Manual M-39 (Management of Delivery Services), I believe that my route qualifies for a special mail count and route inspection Letters of warning in lieu of time–off suspensions may be issued in lieu of either 7–day or 14–day time–off suspension only Article 8 FMLA - (union Forms) Heat Injury Initial Report Form San Antonio, TX 78233 This form is used to request information needed for the grievance, request union time to work the grievance, interview witnesses, and to request an Informal A meeting 9 5 Prior to filing the CA-2, you need to explain your day-to-day duties as a letter carrier to your doctor Fillable Information Request Form Installation/Work Unit 6 PTF Handbook A Checklist for some of the information that may be requested for a grievance After completion of Part I, it must be submitted to the applicant's supervisor for completion of Part II Defenses to Discipline The form will help to fully document the circumstances around the appeal request and will also help to ensure a timely review of the appeal Select a link PS Form 8190 - Fillable Grievance Worksheet - Fillable Information Request - Fillable Informal A Resolution - Fillablle The advanced tools of the editor will guide you through the editable PDF template Formal Step A Reolution: Carrier paid $250 and medical bills paid when management fails to provide them with a Form CA-1 National Association of Letter Carriers Branch 40 (NALC) 9700 Rockside Road, Suite 110 Valley View, Ohio 44125 Phone: 216 Branch 11 represents over 4,800 Letter Carriers and Retiree’s in the Illinois 1 and Illinois 2 Districts of the United Postal Service Request For Extension Since it was founded in 1889, the union has defended the rights of letter carriers while protecting the integrity of the USPS 210-368-1784/1760 Alamo Branch 421 Heat Injury - Initial Report Form After Parts I and II have been completed, this form must be submitted to the Time Limit Extension Informal Step A _____ Formal Step A _____ Appeal To Step B _____ (Check One) The parties mutually agree to extend the time limits on the following Informal/Formal Step NRP: Withdrawal or Failure to Provide Limited Duty Grievance Worksheet: Request for grievance time, time to hear an Informal A and appeal to Formal Step A Press Done and download the resulting template to your computer Enter your official identification and contact details PS From 8190 Add-on M-01875 Adobe Acrobat document [46 ” this general right to issue disci- considered for transfer, the date the employee or employer rejects the offer/request 0 KB] Letter Carriers Daily Log - Fillable Form NLRB-4701 - Notice of Appearance docx Our approach is based on decades of clinical weight loss research focused on simple steps combined with personalized tools and support King Boulevard, Memphis, Tennessee 38126, United States (901) 527-2226 Letter Carrier Perfect PS Form 8190-June 2013 Steward's Forms Here you will find links to the JCAM, Stewards Guide, Grievance Starters, Request for Information Forms, Request for Steward/Union Time Forms, overtime tracking forms, Grievance Form PS-8190 forms, M-41 and updates, M-39 and updates, MRS, etc From our early days in 1891, we have been a leading organization in the struggle for economic and social justice Fillable 8190 Form Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) route shall, upon request, receive a special mail count and inspection to be completed within four weeks of the request Grievant Info Worksheet PS Form 3189: Carrier Schedule Change ANY time management refuses to grant or provide a request a separate class action Article 17/31 grievance needs to be filed immediately and a copy included in the case Request to Receive Donated Leave This is a three part form Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) How to Submit an Appeal Message from NALC President Fred Rolando (3-25-2020) M-01915: Promote Social Distancing MOU M-01916: Temporary Carrier Assistants - Covid-19 Message from NALC President Fred Rolando (4-3-2020) Message from NALC President Fred Rolando (4-17-2020) M-01917: Ext Finance No Supervisor Initials 14 P O Box 30755 Salt Lake City UT 84130-0755 When Medicare is the primary payer, and will not cover your services, call the Plan at 703-729-4677 or 888-636-NALC (6252) to obtain benefits President – Branch 421 com Therefore, as stated in the provisions of the M-39, I request this special count and inspection within four (4) weeks of this notice (Include area code) 3 Branch 908, NALC, AFL-CIO P San Antonio,TX 78284 pdf 41 PS Form 8190-Item 17 Gould@nalc421 Light Duty Request PS Form 8190 LOW - Rescind and Remove Remedy (Fillable) PS Form 8190 LOW - Reduced to Official Discussion Remedy (Fillable) grievance, the union steward may appeal the grievance by: Completing the "Informal Step A" section at the top of the form, Obtaining the supervisor’s initials in Item 13, and Forwarding the form to union and management Formal Step A representatives within 7 days of the discussion 7 NALC Health Benefit Plan 20547 Waverly Court Ashburn, VA 20149 Form 41 - Complete this questionnaire in full when you or a covered family member have: 1) coverage under any other health plan 2) automobile insurance that pays health care expenses without regard to fault 3) Medicare coverage, or 4) a workplace-related illness or injury 10 Our approach is based on decades of clinical weight loss research focused on simple steps combined with personalized tools and support Grievant’s SSN 5 Select a link 3971 - Leave Request - Fillable 1164 - Travel Expenses 3970R - Request to receive donated leave 3970D - Request to Donate leave WABASH AVE Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) Last Day Tracking-Step B Appeal Grievance Extension For copies of supervisor discipline records Weingarten Rights PS Form 8190 3 KB] Stewards’ Storehouse Letter carriers delivered 156 billion pieces of mail last year, six days a week, to more than 153 million homes and businesses in every city, suburb and town in America Adobe Acrobat document [32 Please inform the requestor of any problem with accommodating the requests made National Association of Letter Carriers Branch 79 NALC Forms Click on the brochure to zoom This page is the main resource page for stewards Postal Forms Form NLRB-4483 - Waiver of Eligibility List You will be required to purchase a service in order to access member information online The month of December must be excluded when determining a 6 consecutive week period Steward Guide - NALC Region 13 grievance, the union steward may appeal the grievance by: Completing the "Informal Step A" section at the top of the form, Obtaining the supervisor’s initials in Item 13, and Forwarding the form to union and management Formal Step A representatives within 7 days of the discussion Branch 6000 Request for Information Form PS Form 1199A: Direct Deposit Form RDW Grievance Time Limit Tracking A recent peer-reviewed study demonstrates that Real Appeal delivers a more than 2:1 ROI in just three years You are now leaving the NALC Health Benefit Plan website national agreement Time Limit Extension Informal Step A _____ Formal Step A _____ Appeal To Step B _____ (Check One) The parties mutually agree to extend the time limits on the following Informal/Formal Step NRP: Withdrawal or Failure to Provide Limited Duty MBA Whole Life Insurance is a whole life insurance plan that lets you choose from $10,000, $15,000, $25,000, $50,000, or $100,000 worth of coverage Step 1: Employee narrative Moore O USPS Step B Appeal Cover Sheet PS 8190 Form If customer service is unable to resolve your concern, ask the representative how to appeal Premiums are based on the amount of the policy benefit and your age at the time of purchase Date Discussed with Supervisor (Filing date) 12 Worsham Bldg Grievances NALC-USPS Formal Step A Time Extension (12-20-12) NALC Form 1: Medical Certification-Employee’s Own Serious Health Condition Fill out the Request for Health Care Provider Payment Review form [PDF] Grievance Resolution (Attachment - Item 15 & 19 of PS Form 8190) Article 8 Window of Operations Arbitrations The first step in filing a CA-2 is writing a work narrative PS Form 8190 LOW - Rescind and Remove Remedy (Fillable) PS Form 8190 LOW - Reduced to Official Discussion Remedy (Fillable) From our early days in 1891, we have been a leading organization in the struggle for economic and social justice POM: Postal Operations Manual JCAM All of the Federal Employees Program's online forms (with the exception of Forms CA-16, CA-26 and CA-27) are available to print and to manually fill and submit However, if a period of overtime and/or auxiliary assistance begins in November and continues into January, then January is Request Date: Grievance: Grievant: Pursuant to the Steward’s rights provided for in Articles 17 & 31 of the National Agreement, the following documentation and / or time is requested for the investigation / processing of the grievance identified above Access to forms, grievance starters, handbooks and manuals COVID-19 Decision Tree January 21_2021 v [ Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) 5 Formal Step A Resolutions: Local 3825 Paid $1500 for each Violation of the Rockville Union Time Policy However, if a period of overtime and/or auxiliary assistance begins in November and continues into January, then January is REQUEST FOR SPECIAL ROUTE INSPECTION In accordance with Section 271 of the USPS Manual M-39 (Management of Delivery Services), I believe that my route qualifies for a special mail count and route inspection Help NALC make these bills and resolutions a priority in the U Phone (210)227-0128 Stewards, All grievances originating from San Antonio and surrounding aos should be mailed to: DRT MRS + Defenses to Disciplines Full-time regular opportunities in the city letter carrier craft covered by this memorandum (which are not subject to a proper withholding order pursuant to Article 12 of the collective If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request Application For Permanent Absentee Voter (Los Angeles County) -- Fillable PDF file (fill, print, and sign) Application For Permanent Absentee Voter (Ventura County) -- PDF file (print, fill, and sign) Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) Printable Forms of time limits for Step B & Arbitration M-01918: Signing overtime desired lists Covid-19 Form NLRB-506 – Responsive Statement of Position M-39, M-41, ELM Material Reference System (MRS) Joint Contract Administration Manual (JCAM) NALC Branch 2502 Local Agreement PLEASE ENSURE THAT WE HAVE YOUR CURRENT MAILING ADDRESS ON FILE Request Date: Grievance: Grievant: Pursuant to the Steward’s rights provided for in Articles 17 & 31 of the National Agreement, the following documentation and / or time is requested for the investigation / processing of the grievance identified above Simply click on the appropriate form and print it using the [Print] button provided near the top of the form The above list is just a small example of the most frequently required requests PS From 8190 rev 2016 Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) Chapter 1—Forms of Discipline article 3, section B of the National agreement gives management the right “to suspend, demote, dis-charge, or take other disciplinary action against such employees Letters of warning in lieu of time–off suspensions are PS Form 8190, September 2000 (Page 1 of 2) USPS-NALC Joint Step A Grievance Form 1 pdf steward shall request permission from the immediate supervisor and such request shall not be unreasonably denied Form NLRB-4702 - Annual Notice for Receipt of Charges and Petitions USPS Grievance No Send your Nalc Grievance Template in a digital form right after you finish completing it Join numerous satisfied customers that are already filling out legal forms straight from their houses Grievance – Article 41 Form NLRB-601 - Withdrawal Request With this plan, premiums remain the same throughout the life of your policy Branch 6000 Grievance Time Limit Extension Agreement Form 3 KB] Light Duty Request com 584 South B Unfair Labor Practice Form: NALC Activist : NALC Can Count On Me Form: FSA-1: Flexible Spending Account Claim Form: FSA Worksheet: Flexible Spending Account Worksheet: PS-3971: Request For Leave: MSPB: MSPB Appeal Form: NJ Vote: New Jersey Voter Registration Form: NALC FMLA Forms: NALC FMLA Forms: Steward Time Request: Request For Steward Time FMLA - (union Forms) Heat Injury Initial Report Form 62 Implementation INFORMAL STEP A — NALC Shop Steward Completes This Section Grievance – Article 41 I will be unavailable _____ Please indicate the date and time we will meet: Date _____ Time _____ _____ USPS-NALC Joint Step A Grievance Fillable PS Form 8190 NALC Branch 79 2 – PS Form 1723 Not Provided(Word) Grievance – CCA Conversion AL(PDF) Grievance – CCA Conversion AL(Word) Grievance – CCA Separation(PDF) Grievance – CCA Separation(Word) Grievance – CCA Term Less Than 360 Days(PDF) Branch 3825 Grievance Forms NALC Step B Appeal Cover Sheet-Remand Fact Finding Form B 642 You will be taken to a website hosted by Change Healthcare PS Form 3189 Request for Schedule Change Informal A Worksheet PS Form 3971: Leave Request Form Cigna also has a three-step process to appeal or request review of coverage decisions Merit System Protection Board Appeal (MSPB) Form: Grievance Investigation: 1838C Training Online: Shared Services Phone AND WE'LL BE GLAD TO ADD YOU TO THE BRANCH E-MAIL LIST PS Form 1767 Report of Hazardous Condition ©2020 by Branch 1779 NALC, AFL-CIO G Attachment to 8190 Remedy Unless required by statute, suspensions of more than 14 days are prohibited except for indefinite suspensions referenced in 651 Fax (210)-226-8119 Grievance Checklist doc 39 To get a printable copy of a form click on the appropriate link below In support of this goal, we have put a process in place to address your concerns and complaints We request that the following documents and/or witnesses be made available to us in order to properly identify whether or not a grievance does exist and if so, their relevancy to the grievance Fillable 8190 (PDF) Expense Report (PDF) CCA Conversion To Regular Report (PDF) Form H101 01/22 Continued on Back HIGH OPTION N A T I O N A L A S S O C I A T I O N O F L E T T E R C A R R I E R S HEALTH BENEFIT PLAN 20547 Waverly Court, Ashburn, Virginia 20149 703-729-4677 or 888-636-NALC (6252) Any questions, contact the branch Fillable Request for Steward Time Form 6218 Krempen Ave Grievant’s Name (Last, first, middle initial) 2 Grievance Procedure Timeline Chart In addition, we request any and all evidence (including supervisory notes and witness statements) You are now leaving the NALC Health Benefit Plan website doc 36 Proudly created with Wix All forms should be fully completed, including selecting the appropriate check box for the reason for the List of USPS Forms INFORMAL STEP A — NALC Shop Steward Completes This Section The way to complete the Earmark appEval form online: To start the blank, use the Fill camp; Sign Online button or tick the preview image of the document USPS-NALC Joint Step A Grievance Form INFORMAL STEP A — NALC Shop Steward Completes This Section (See instructions on page 2 Letter Carriers Daily Log - Fillable Likewise, the Request Date: Grievance: Grievant: Pursuant to the Steward’s rights provided for in Articles 17 & 31 of the National Agreement, the following documentation and / or time is requested for the investigation / processing of the grievance identified above Information Request Form Congress! NALC Branch 27 Application For Permanent Absentee Voter (Los Angeles County) -- Fillable PDF file (fill, print, and sign) Application For Permanent Absentee Voter (Ventura County) -- PDF file (print, fill, and sign) We need to start filing grievances on this issue if it occurs to one of the carriers at your station NALC is the sole representative of city letter carriers employed by the United States Postal Service Health Benefits Registration Form : 2810: Notice of Change in Health Benefits Enrollment : 2944: Receipt for Customs Duty Mail : 3074: Request for Waiver of Claim for Erroneous Payment of Pay : 3076: Request to Cancel or Change Salary Allotment : 3189: Request for Temporary Change of Schedule : 3521: Carrier's Report on House Numbers and Mail Forms Receive Donated Leave, PS Form 3970-R YOU MAY ALSO RECEIVE UP TO DATE INFORMATION VIA E-MAIL NALC Branch 27 A doctor needs to read the narrative and write a medical report that links the diagnosed injury to specific work factors PS Form 1571: Curtail Mail